Agoraphobia — MCQs
A middle-aged person reported to the Psychiatric OPD with complaints of fear of leaving home, fear of traveling alone, and fear of being in a crowd. He develops marked anxiety with palpitations and sweating when he is in these situations. He often avoids public transportation to go to his place of work. The most likely diagnosis is
For which condition is behaviour therapy helpful?
In which of the following conditions is behavior therapy considered most effective?
A 24-year-old lady presented with sudden onset chest pain, palpitations lasting for about 20 minutes. She says there were 3 similar episodes in the past. All the investigations were normal. What is the likely diagnosis?
Post-traumatic stress disorder is characterized by all except:
The most common cause of hyperthyroidism in a young female is?
Prognosis of schizophrenia is best, if:
Fear of "places from where escape is difficult" is called ______
Along with a pleasant stimulus, noxious stimuli are given in the treatment of alcohol dependence or sexual disorder. This is which of the following types of behavior therapy?
A patient presented in casualty with a history of sudden palpitation, sensation of impending doom, and constriction in his chest. This lasted for about 10-15 minutes after which he recovered. What is the likely diagnosis?
Agoraphobia Indian Medical PG Practice Questions and MCQs
Question 1: A middle-aged person reported to the Psychiatric OPD with complaints of fear of leaving home, fear of traveling alone, and fear of being in a crowd. He develops marked anxiety with palpitations and sweating when he is in these situations. He often avoids public transportation to go to his place of work. The most likely diagnosis is
- A. Generalised anxiety disorder
- B. Schizophrenia
- C. Personality disorder
- D. Agoraphobia (Correct Answer)
Explanation: ***Agoraphobia*** - The patient's presentation of **fear of leaving home**, traveling alone, and being in a crowd, along with marked anxiety symptoms like palpitations and sweating when in these situations, are classic signs of **agoraphobia**. - **DSM-5 diagnostic criteria** require fear/anxiety about ≥2 of the following: public transportation, open spaces, enclosed spaces, crowds, or being outside home alone—this patient meets multiple criteria. - **Avoidance behavior** of public transportation and the associated functional impairment (difficulty going to work) directly align with agoraphobia, where individuals actively avoid situations that trigger anxiety or panic symptoms. - The anxiety is **situation-specific** rather than generalized, with clear autonomic symptoms (palpitations, sweating) triggered by specific environmental contexts. *Generalised anxiety disorder* - While GAD involves **excessive worry** about various aspects of life, it typically doesn't present with specific fears related to being in certain places or situations with such intense avoidance behaviors. - The anxiety in GAD is **pervasive and free-floating**, not situation-specific—it lacks the characteristic **fear of open or public spaces** and targeted avoidance seen in this case. - GAD worry is difficult to control and involves multiple life domains, not restricted to specific environmental triggers. *Schizophrenia* - Schizophrenia is a **psychotic disorder** characterized by hallucinations, delusions, disorganized thought, and negative symptoms; it does not primarily manifest as specific phobias or anxiety related to public spaces. - The patient's symptoms do not align with the core features of **psychosis**, such as impaired reality testing, thought disorders, or perceptual disturbances. - Social withdrawal in schizophrenia is due to negative symptoms or paranoid delusions, not situation-specific anxiety with autonomic arousal. *Personality disorder* - Personality disorders involve **long-standing maladaptive patterns** of thinking, feeling, and behaving across various contexts, rather than specific phobias and anxiety attacks in particular situations. - The symptoms described are acute situational anxieties with clear triggers and avoidance, not a pervasive and enduring pattern of inner experience and behavior typical of a **personality disorder**. - Onset would typically be traceable to early adulthood with chronic interpersonal dysfunction, unlike the symptom-focused presentation here.
Question 2: For which condition is behaviour therapy helpful?
- A. Schizophrenia
- B. Personality Disorder
- C. Agoraphobia (Correct Answer)
- D. Neurotic depression
Explanation: ***Agoraphobia*** - **Behavior therapy**, especially **exposure therapy**, is highly effective for agoraphobia by gradually exposing individuals to feared situations. - It helps patients learn new coping mechanisms and reduce avoidance behaviors associated with anxiety. *Schizophrenia* - While supportive and skills-based therapies can be beneficial, **behavior therapy alone is not the primary or most effective treatment** for core psychotic symptoms. - Treatment typically involves **antipsychotic medication** combined with psychotherapy. *Personality Disorder* - **Dialectical behavior therapy (DBT)**, a specific type of cognitive-behavioral therapy, is effective for some personality disorders, particularly **borderline personality disorder**, but general behavior therapy alone is not comprehensive enough for the broad spectrum of personality disorders. - These conditions often require a **multi-modal approach** addressing deep-seated thought patterns and relationship issues. *Neurotic depression* - **Cognitive-behavioral therapy (CBT)** is an effective treatment for depression, but it is a broader approach that includes cognitive restructuring in addition to behavioral techniques. - Purely behavioral interventions may address some symptoms but often don't tackle the underlying cognitive distortions common in depression.
Question 3: In which of the following conditions is behavior therapy considered most effective?
- A. Panic Attack
- B. Psychosis
- C. Obsessive-Compulsive Disorder (OCD) (Correct Answer)
- D. Generalized Anxiety Disorder
Explanation: ***Obsessive-Compulsive Disorder (OCD)*** - **Exposure and Response Prevention (ERP)**, a type of behavior therapy, is the gold standard and most effective treatment for OCD. - ERP directly targets the **obsessions** and **compulsions** by gradually exposing individuals to feared situations without allowing them to perform their rituals. - OCD shows the **highest response rates** to pure behavior therapy compared to other psychiatric conditions. *Psychosis* - While supportive therapy and cognitive behavioral therapy for psychosis (CBTp) can be helpful, **behavior therapy alone is not considered the primary or most effective treatment** for core psychotic symptoms. - Management of psychosis primarily relies on **antipsychotic medications** to address symptoms like hallucinations and delusions. *Panic Attack* - Behavior therapy and CBT are effective for **Panic Disorder**, but the effectiveness is somewhat lower than for OCD. - Treatment for panic disorder often requires a **combination of behavioral and cognitive techniques** rather than pure behavior therapy alone. - Management typically includes breathing exercises, exposure to physical sensations, and cognitive restructuring. *Generalized Anxiety Disorder* - **Cognitive Behavioral Therapy (CBT)**, which includes behavioral components, is highly effective for GAD, but the **cognitive elements are essential** for addressing worry and rumination. - Pure behavior therapy (e.g., systematic desensitization) is less effective for GAD compared to OCD, as GAD involves pervasive cognitive distortions that require cognitive restructuring.
Question 4: A 24-year-old lady presented with sudden onset chest pain, palpitations lasting for about 20 minutes. She says there were 3 similar episodes in the past. All the investigations were normal. What is the likely diagnosis?
- A. Post-traumatic stress disorder
- B. Acute psychosis
- C. Panic attack (Correct Answer)
- D. Mania
Explanation: ***Panic attack*** - The sudden onset of **chest pain** and **palpitations** in a young woman, lasting for a brief period (20 minutes), and occurring in recurrent episodes with all investigations being normal, are classic signs of a **panic attack**. - Panic attacks frequently mimic cardiac events, but the absence of organic findings despite recurrent episodes points towards a psychological origin. *Post-traumatic stress disorder* - While PTSD can involve symptoms of anxiety and panic, it is specifically triggered by a **traumatic event** and typically includes re-experiencing the trauma, avoidance, and hyperarousal, none of which are described here. - The patient's presentation primarily focuses on sudden physical symptoms rather than a direct link to past trauma or pervasive fear. *Acute psychosis* - Acute psychosis involves a severe break from reality, characterized by **hallucinations**, **delusions**, or disorganized thought and behavior, which are not present in this scenario. - The symptoms described are more consistent with an anxiety disorder rather than a thought disorder. *Mania* - Mania is a state of elevated mood, increased energy, and often includes symptoms like **reduced need for sleep**, **racing thoughts**, and **impulsive behavior**, which are not described in this patient's presentation. - The core symptoms are acute physical sensations of fear and discomfort, not sustained euphoria or grandiosity.
Question 5: Post-traumatic stress disorder is characterized by all except:
- A. Flashback and nightmare
- B. Re-experiencing stressful events
- C. Exposure to traumatic events
- D. It doesn't develop after 6 months of stress (Correct Answer)
Explanation: ***It doesn't develop after 6 months of stress*** - This statement is **FALSE** and is therefore the correct answer to this "EXCEPT" question. - **PTSD can develop at any time** following a traumatic event, including months or even years later - there is no upper time limit for symptom onset. - The **DSM-5 includes a "delayed expression" specifier** for cases where full diagnostic criteria are not met until at least 6 months after the trauma. - While most cases develop within **3 months of the traumatic event**, delayed onset is well-documented and clinically recognized. - This distinguishes PTSD from **Acute Stress Disorder**, which by definition occurs within 3 days to 4 weeks after trauma exposure. *Flashback and nightmare* - **Flashbacks** (dissociative reactions where the person feels the traumatic event is recurring) and **nightmares** are core symptoms of PTSD. - These belong to the **re-experiencing/intrusion symptom cluster** (Criterion B in DSM-5). - These involuntary recollections cause significant distress and are hallmark features of the disorder. *Re-experiencing stressful events* - **Re-experiencing symptoms** are one of the four main symptom clusters required for PTSD diagnosis. - This includes intrusive memories, traumatic nightmares, flashbacks, and intense psychological/physiological reactions to trauma reminders. - These symptoms reflect the **inability to integrate the traumatic memory** properly, leading to involuntary reactivation. *Exposure to traumatic events* - **Criterion A: Exposure to actual or threatened death, serious injury, or sexual violence** is the essential prerequisite for PTSD diagnosis. - This exposure can be through direct experience, witnessing, learning it happened to a close other, or repeated/extreme exposure to aversive details. - Without documented trauma exposure, PTSD cannot be diagnosed regardless of symptom presentation.
Question 6: The most common cause of hyperthyroidism in a young female is?
- A. TSH-secreting pituitary adenoma
- B. Graves' disease (Correct Answer)
- C. Subacute thyroiditis
- D. Toxic multinodular goiter
Explanation: ***Graves' disease*** - This is an **autoimmune disorder** where antibodies stimulate the thyroid gland, leading to **overproduction of thyroid hormones** [1], [2]. - It is the **most common cause of hyperthyroidism** in young to middle-aged women, making it highly probable in a young female patient [1], [2]. *Toxic multinodular goiter* - This condition is characterized by **multiple nodules** within the thyroid gland that autonomously produce thyroid hormones. - While a cause of hyperthyroidism, it is **more common in older individuals**, typically those over 50 years of age. *Subacute thyroiditis* - This is a **self-limiting inflammatory condition** of the thyroid often following a viral infection, causing a transient hyperthyroid phase due to the release of preformed hormones. - It presents with **painful thyroid enlargement** and is usually followed by a hypothyroid phase, which is different from sustained hyperthyroidism. *TSH-secreting pituitary adenoma* - This is a **very rare cause of hyperthyroidism** where a pituitary tumor produces excess **Thyroid-Stimulating Hormone (TSH)**, leading to thyroid overstimulation. - It is often accompanied by other symptoms of a pituitary mass like **headaches or visual field defects**, which are not implied here.
Question 7: Prognosis of schizophrenia is best, if:
- A. Acute onset (Correct Answer)
- B. Negative symptoms
- C. Insidious onset
- D. Family history is positive
Explanation: ***Acute onset*** - An **acute onset** of schizophrenia is associated with a better prognosis, as it often indicates a more favorable response to treatment and less pervasive deterioration of daily functioning. - This typically suggests that the individual had a relatively intact baseline level of functioning before the emergence of psychotic symptoms. *Negative symptoms* - The presence of prominent **negative symptoms** (e.g., avolition, anhedonia, alogia) is usually associated with a poorer prognosis in schizophrenia. - Negative symptoms are generally harder to treat and often lead to greater functional impairment and disability. *Insidious onset* - An **insidious onset** of schizophrenia, where symptoms develop gradually over time, is typically linked to a poorer prognosis. - This often implies more severe and persistent neurodevelopmental abnormalities and a less robust response to interventions. *Family history is positive* - A **positive family history** of schizophrenia indicates a higher genetic predisposition but does not directly predict the individual's prognosis. - While genetics play a role in susceptibility, the course and outcome of the illness are influenced by many other factors, including symptom presentation and treatment adherence.
Question 8: Fear of "places from where escape is difficult" is called ______
- A. Claustrophobia
- B. Aerophobia
- C. Agoraphobia (Correct Answer)
- D. Ailurophobia
Explanation: ***Agoraphobia*** - **Agoraphobia** is the intense fear and anxiety of situations or places that might be difficult to escape from or where help might not be available, such as open spaces, crowds, or public transportation. - Individuals with agoraphobia often avoid these situations or endure them with extreme distress, sometimes resulting in being housebound. *Claustrophobia* - **Claustrophobia** is the intense fear of tight, enclosed spaces, such as elevators, small rooms, or MRI machines. - This phobia is distinct from agoraphobia, which centers around difficulty escaping rather than the space itself. *Aerophobia* - **Aerophobia** is the fear of flying, specifically involving airplanes or other forms of air travel. - It is a specific phobia related to a particular situation, not a generalized fear of inescapable places. *Ailurophobia* - **Ailurophobia** is the irrational fear of cats. - This is a specific animal phobia and has no relation to the fear of open spaces or situations from which escape might be difficult.
Question 9: Along with a pleasant stimulus, noxious stimuli are given in the treatment of alcohol dependence or sexual disorder. This is which of the following types of behavior therapy?
- A. Negative reinforcement
- B. Aversion therapy (Correct Answer)
- C. Punishment
- D. Flooding
Explanation: ### Explanation **Correct Answer: B. Aversion Therapy** **Aversion therapy** is a form of behavior therapy based on the principle of **Classical Conditioning**. It involves the repeated pairing of an undesirable but pleasant stimulus (e.g., alcohol or paraphilic triggers) with an unpleasant/noxious stimulus (e.g., electric shocks, emetics like disulfiram, or unpleasant odors). Over time, the patient develops a conditioned aversion to the previously pleasurable stimulus, leading to a reduction in the unwanted behavior. It is commonly used in treating alcohol dependence, smoking, and certain sexual disorders. **Why other options are incorrect:** * **A. Negative Reinforcement:** This involves the **removal** of an unpleasant stimulus to increase the frequency of a desired behavior (e.g., taking an aspirin to remove a headache). In the question, a noxious stimulus is *added*, not removed. * **C. Punishment:** While similar, punishment is an **Operant Conditioning** concept where a consequence follows a behavior to decrease its frequency. Aversion therapy is specifically the *pairing* of stimuli to change the emotional response (Classical Conditioning). * **D. Flooding:** This is a technique used for phobias and OCD where the patient is directly exposed to their maximum feared stimulus (prolonged exposure) until the anxiety response extinguishes. It does not involve noxious stimuli like shocks or chemicals. **High-Yield Clinical Pearls for NEET-PG:** * **Disulfiram (Antabuse):** A classic example of aversion therapy (pharmacological) used in alcohol dependence by causing a toxic reaction (DER). * **Covert Sensitization:** A variation of aversion therapy where the noxious stimulus is merely **imagined** rather than physically applied. * **Systematic Desensitization:** The opposite of flooding; it involves graded exposure combined with relaxation techniques (based on reciprocal inhibition).
Question 10: A patient presented in casualty with a history of sudden palpitation, sensation of impending doom, and constriction in his chest. This lasted for about 10-15 minutes after which he recovered. What is the likely diagnosis?
- A. Phobia
- B. Personality disorder
- C. Generalized Anxiety disorder
- D. Panic attack (Correct Answer)
Explanation: ### Explanation **Correct Option: D. Panic attack** The clinical presentation describes a classic **Panic Attack**. It is characterized by an abrupt surge of intense fear or discomfort that reaches a peak within minutes. Key diagnostic features present in this case include **autonomic hyperactivity** (palpitations), **chest discomfort** (constriction), and **cognitive symptoms** (sense of impending doom). A hallmark of panic attacks is their discrete nature—they typically last for 10–30 minutes and resolve spontaneously. **Why other options are incorrect:** * **A. Phobia:** While phobias can trigger panic symptoms, they are always linked to a **specific stimulus** (e.g., heights, spiders). The question describes a spontaneous episode without a specific trigger. * **B. Personality disorder:** These are enduring, pervasive patterns of behavior and inner experience that deviate from cultural expectations. They do not present as acute, episodic physical symptoms. * **C. Generalized Anxiety Disorder (GAD):** GAD is characterized by "free-floating anxiety" and excessive worry about daily events lasting for **at least 6 months**. It lacks the sudden, crescendo-like intensity and discrete "attack" nature seen here. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis of Panic Disorder:** Requires recurrent *unexpected* panic attacks followed by at least **one month** of persistent concern about future attacks or behavioral changes. * **Physical Mimics:** Always rule out Medical emergencies like Myocardial Infarction (MI), Pheochromocytoma, or Hyperthyroidism. * **Treatment:** * **Acute episode:** Benzodiazepines (e.g., Alprazolam, Lorazepam). * **Long-term/Prophylaxis:** SSRIs (Drug of Choice) + Cognitive Behavioral Therapy (CBT). * **Associated Symptom:** **Agoraphobia** (fear of places where escape might be difficult) frequently co-occurs with Panic Disorder.
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